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DERMATOLOGY
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Early syphilis
Includes :-Primary , secondary and latent stage
KEERTHI NS
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Syphilis:-
A venereal disease caused by spirochaetes, treponema pallidium .
Evidence and Information for Policy
HISTORICAL ASPECTSHISTORICAL ASPECTS
The exact origin of syphilis is unknown.
2 PRIMARY HYPOTHESIS:
COLUMBIAN HYPOTHESIS
SYPHILIS WAS CARRIED TO EUROPE
BY RETURNING CREWMEN FROM
AMERICA BY CHRISTOPHER
COLUMBUS’S VOYAGES PRE-COLUMBIAN HYPOTHESISPROPOSES SYPHILIS
EXISTED IN EUROPE PREVIOUSLY’BUT WENT
UNRECOGNIZED
• Italian physician and poet • 1530• Latin poem ‘syphilis sive
morbus gallicus’ describing the ravages of the disease in Italy.
• Coined the name from the legend of a shepherd called Syphilus who had purportedly gotten the illness as a punishment for defying the god APPOLO
Girolamo Fracastoro
JHON HUNTER• The notorious self
experimentation of hunter by inoculating himself with gonococcal pus to see if gonorrhoea and syphilis were manifestation of same infection.
• Later he developed classical syphilitic heart disease due to which he died in 1739.
PHILLIPPE RICORDHe classified syphIlis into primary ,secondary and tertiary stages.
He distinguished gonorhoea from syphilis after carrying out over 2500 inoculations in humans.
Etiology
Treponema pallidum• A spirochete; corkscrew
shaped• Motile with characteristic
movements like angulation,bending,rotatory motion and back and forth squiggle
Transmission
Acquired
Mainly sexual
Rarely via blood
Accidental
Congenital
Trans placentally
Mode of transmission
syphilis
Early syphilis
Infections < 24 months; highly infectious
Late syphilis
Infection > 24months; not infectious
Classification of syphilis
9-90 days
3-12 weeks EARLY SYPHILIS;Highly infectious
24 MONTHS
LATE SYPHILIS
Stages of syphilis
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Different manifestations occur depending on the
stage of the disease
Signs&
symptoms
primary
secondary
latent
tertiary
Congenital* Early* late
Clinical features:-
Primary syphilis
Morphology of lesion Location of lesion Lymphadenopathy
Morphology
• In 50% of patients ,the typical lesion is called Hunterian chancre
• Features:-
Single,painlessRegular,indurated(button
like)Reddish
plaque;frequently ulcerates
Ulcer:-oozes clear serum on pressure
Heals spontaneously (4-6 weeks) or on treatment
Primary syphilis
• In the rest 50%,the ulcers are atypical o Painfulo Multipleo Indurated
Location of ulcers
Male genital areas:-
Coronal sulans
Glans
Prepuce
Shaft of penis
Perianal areas in homosexual males
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Females:-
Labia minora
Labia majora
Mons pubis
Sometimes in vagina or cervix
Extra genital lesions:-• Lips• Nipples• Fingers
Lymphadenopathy in PS
Inguinal:-• Multiple• Small• Firm
Secondary syphilis
• Systemic disease with cutaneous as well as extracutaneous manifestations.
• It manifest itself 3- 12 weeks after the appearance of primary chancre.
Cutaneous lesion in SS
• Skin lesions may be a few or numerous
• Lesions are symmetrical early , become asymetrical later
• Rashes; of any morphologyMacular Papular Papulo squamousNodular
Types of rashes in SS
Roseolar syphilide
Papular syphilide
Psoriasiform lesion
Malignant syphilide
Roseolar syphilide
Symmetrical erythematous macular rashes
Papular syphilide
Most common rash of SS
Dull red papules, initially discrete
Later coalesce to form annular lesions
Psoriasiform lesion
• When scaling is predominant
Malignant syphilide
• Pustular• Necrotic • Rupioid lesions
in Immuno compromised patients.
•Hyper pigmented, coppery red, scaly lesions
Palm and sole
lesions
• In intertriginous area, the papules may erode superficially
Condyloma lata:
Mucosal lesions
•Dull erythematous plaques with grayish slough
Mucosal
patches:
•Mucous patches with serpiginous erosions
Snail-track
ulcers:
Lymphadenopathy in SS
• Generalised, symmetrical, and rubbery
AxillaryCervicalInguinal
Systemic involvement in SS
• SS is a systemic disease with invovement of many organ
system:• Musculo-skeletal system:
• Periostitis , arthritis• Ocular:
• Iridocyclitis, uveitis, choroidretinitis• Renal:
• Nephrotic symdrome• CNS:
• CSF Abnormalities
Latent syphilis• Patient has only serological
evidence of syphilis without any clinical evidence.
• Depending on the number of of years passed :Early latent (<2 yrs)Late latent syphilis(>2yrs)
TERTIARY SYPHILIS
• It manifest 3-10 years after the primary stage
TERTIARY SYPHILIS• Mucocutaneous tertiary
– Gumma*(well defined punched out ulcer)
• Neurosyphilis– Asymptomaticparenchymatous
/meningeal
• CVS syphilis– Aortitis– coronary stenosis– aneurysm
CONGENITAL SYPHILIS
CONGENITAL SYPHILIS
• T.Pallidum can be transmitted by an infected mother to foetus in utero
EARLY CONGENITAL SYPHILIS
.Appear with in first 2 yearof life Signs First appear 3rd-8th week of lifeA form of rhinitis is the first specific finding. In severe infection there is classic picture of marasmic syphilis-wrinkled pot bellied old man.
Cutaneous eruptions,hepatosplenomegaly,bone and joint involvement are common.C/F similar to acquired SS but visceral and bone involvement are more common.
Cutaneous lesions:bullous,
fissuring of lips,nasolabial
folds
Late congenital syphilis
• Hutchison’s triad– Hutchinson’s teeth– Interstitial keratitis– 8th nerve deafness.
• Other manifestations – Saddle nose– Frontal bossing– Cluttons joint(painless
swelling of joint
DIAGNOSIS
Demonstration of T.pallidumDark ground microscopyDirect immunofluroscent
stainingRecent method-ELISA and
PCR have failed to improve diagnostic detection rates.
Serological testing
• VDRL[Non treponemal/Reaginic test] is good screening test and + in case of most SS & also in tertiary syphilis.
• Confirmatory test (treponemal)-TPHA,TPI, FTA - ABS
Csf examination and chest radiography:- in tertiary syphilis.
Skin biopsy may be used for histopathologic changes and organisms in tissue can be demonstrated by silver staining.
Chancre – IP:9-90 days– Painless, single
– Margin: regular– inflammatory zone: absent– Button-like; induration– Lymphadenopathy :shotty;
may be b/l, nontender– nonsuppurative – VDRL: +/_ve– DG M/S:+VE
Chancroid– 3-5 days– Very painful,Ulcer
inflamed,multiple
– Irregular– present– Soft, covered by a
membrane– Lymphadenopathy:bubo;
u/l, tender– suppurative– _ve– _VE
Differential diagnosis
TREATMENT
COUNSELING• Advice on safe sex:Use of
condoms.• Sex avoidance till healing
of lesions• Follow up testing for
HIV;hep B virus & VDRL at 3 months & further if necessary
TREATMENTEarly syphilis
-Benzathine penicillin(2.4 mega dose)
Late syphilis– Three week i/m
injection of benzathine penicillin